Interpretive Summary: Adolescence is a critical life stage in the development of dietary behaviors such as fast food use which often continue through adulthood and therefore can influence the risk of chronic disease. Research has shown that fast food has deleterious effects on dietary intake, yet no evaluation of how it affects meeting the national standards outlined in USDA’s MyPyramid Food Guidance System has been conducted. To address this issue, a secondary analysis of data from the What We Eat in America, National Health and Nutrition Examination Survey 2003-2004 was performed. The objective of this study was to measure associations between adolescent fast food use and intake of food groups and meeting MyPyramid recommendations. Differences in food intake and proportion meeting MyPyramid recommendations by fast food level were determined. MyPyramid food groups/components which significantly increased or decreased as the proportion of total energy intake from fast food increased were identified. In addition, the relative likelihood of meeting MyPyramid intake recommendations by fast food intake tertile was determined. Awareness of fast food's role in discrepancies between adolescent intakes and MyPyramid recommendations is useful information for practitioners in planning effective nutrition education strategies to improve adolescents' diets.

Technical Abstract: The goals of this study were to determine the effect of fast food consumption on adolescents’ food group intakes and likelihood of meeting recommendations outlined in USDA’s MyPyramid Food Guidance System. Two days of 24-hour recall data from 1,956 adolescents 12-19 years of age collected in What We Eat in America, National Health and Nutrition Examination Survey 2003-2004 were analyzed. Fast food consumers were divided into tertiles based on the proportion of 2-day energy intake derived from fast food. Regression analyses with adjustment for confounding factors including energy intake were used to detect associations between fast food consumption and both food group intakes and percentages of individuals meeting MyPyramid recommendations, and to predict odds of meeting recommendations by fast food consumption level. Increasing fast food intakes were associated with decreasing intakes from the MyPyramid fruit and milk groups for adolescent boys and girls and increasing intakes of discretionary calories and solid fats for girls only (p<0.05). Fast food consumption was also associated with decreasing percentages of adolescents meeting vegetable and discretionary energy recommendations, and those in the highest tertile of fast food intake were less likely to meet recommendations for these MyPyramid groups than were those who consumed no fast food. The percentages of boys meeting milk recommendations and girls meeting fruit recommendations decreased as fast food increased. Intakes of grain, meat/beans, and oils were not associated with fast food intake. Diets of most adolescents, whether consuming fast food or not, need considerable improvement. Fast food is one factor that impacts adolescents’ intake of MyPyramid groups and their likelihood of meeting recommendations. Awareness of fast food's role in discrepancies between adolescent intakes and MyPyramid recommendations can aid practitioners in designing effective nutrition education strategies to improve adolescents' diets.